News Highlights
Intrauterine devices may be a preferable contraception to hormonal methods for women with weakened immune systems
Intrauterine devices (IUDs) are a safe bet for long-term pregnancy protection, and may even be a preferable option to hormonal contraception for women who have conditions that compromise their immune systems, contrary to the misconceptions about the safety of the devices.
The copper IUD works partly through an immune system response, triggering the body to create an environment that is naturally hostile toward sperm. The IUDs’ bad reputation has followed it since the 1970s, when a device called the Dalkon shield was pulled off the market after causing serious harm to women, such as infections. Many women and physicians still believe that IUDs may cause complications, but the devices on today’s markets are in fact safe and highly effective, designed differently than their notorious predecessor.
According to a recent study of 649 women, some with abnormally functioning immune systems, the risk of infections, such as pelvic inflammatory disease, with today’s IUDs is insignificant, even among women who are infected with HIV. Another study reports no difference in the rates of infection between women with HIV using the copper IUD compared to hormonal contraception. However, hormonal contraception use was associated with the progression of the disease.
Copper IUDs are also a good contraceptive method for women who have lupus, another disease that decreases immunity. Use of the copper IUD did not result in increased rates of infection and disease activity.
Higher failure rates with copper IUD have been reported in women taking strong medications to suppress their immune system because of an organ transplant. An intrauterine system (IUS) may be preferable in this circumstance—it also releases a progestin that thins the lining of the uterus, and thickens the cervical mucus making it harder for sperm to enter the uterus. This progestin releasing IUS also benefits women who have heavy menstrual periods.
Browne J, Manipalviratn S, Armstrong A. Using an Intrauterine Device in Immunocompromised Women. Obstet Gynecol 2008;112:667-9.
What are the risks of sexual activities other than penile-vaginal intercourse?
Many couples engage in mutual masturbation, oral sex and anal sex instead of penile-vaginal intercourse to prevent pregnancy and avoid catching sexually transmitted infections (STIs). These activities reduce the risk of pregnancy, but most people don’t know that the risk of spreading an STI stays significantly high.
Various infections may be spread through blood, saliva, semen, and feces. Different organisms have different risks of being spread, but the risk is always increased with open sores and abrasions, or other breaks in the skin, oral or vaginal lining.
Only 11-15% of individuals aged 15-17 years reported using a condom last time they engaged in oral sex, according to a U.S. survey.
HIV (Human Immunodeficiency Virus) – The risk of transmission varies greatly with the type of sexual activity. The highest risk occurs with receptive anal intercourse. Condom use reduces the risk by 80%. Although oral sex has a relatively lower risk, there have been cases of HIV infection in men who only engage in oral sex with other men.
Genital Herpes (HSV) – HSV type 1 (commonly oral) and type 2 (commonly genital) are both known to cause oral, genital and anal lesions. It is common for HSV to be transmitted through kissing and through oral, vaginal or anal sex.
Human Papilloma Virus (HPV) – More than 90% of HPV infections will resolve spontaneously, but certain types of HPV can persist and have the potential to cause precancerous lesions and eventually cancer. Penile-vaginal and penile-anal transmission are the most common, but oral transmission can occur. There is a new vaccine available for HPV.
Hepatitis Viruses – Hepatitis B virus is found in various body fluids and is commonly transmitted with many types of sexual activity. Hepatitis C, although capable of spreading in this manner, is not commonly spread through sexual activity.
Bacterial Infections – More than 13% of recent syphilis cases in Chicago were transmitted through oral sex. Gonorrhea and Chlamydia may be transmitted by any of the aforementioned practices. It can also cause throat infections (pharyngeal), although most of the time people are unaware of this type of infection.
Addressing health risks of noncoital sexual activity. ACOG Committee Opinion No. 417. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;112:735-7.
Managing breakthrough bleeding with continuous use of the contraceptive ring
Temporary removing the transvaginal contraception ring may decrease pelvic pain, and the number of days of breakthrough bleeding a woman may experience, according to a new study.
Nuvaring® was originally designed to be placed in the vagina for three weeks followed by one ring-free week before placing a new ring, mimicking the traditional regimen of taking combined oral contraceptives. However, the ring has been shown to be effective for contraception for at least 28 days if it is left in place. The most common side effect of this type of extended or continuous use is breakthrough bleeding or spotting.
This study randomly assigned 74 women (ages 18-45) willing to use the Nuvaring® to one of two groups, examining the volumes of bleeding each day with a scoring system.
- Group 1 used the ring continuously for 6 months regardless of bleeding, and they replaced the ring monthly, on the same day of the month.
- Group 2 also used the ring continuously, but if they had prolonged breakthrough bleeding or spotting (more than 5 days), they were instructed to remove the ring for 4 days, store it, then reinserted the same ring until the end of the month. The ring was replaced monthly
Before the study, participants used the ring for two months in the traditional way—three weeks in and one week out, where the bleeding scores were the same between the groups.
Key findings:
- During the six months of continuous use, the women in both groups experienced reduced average daily flow.
- Group 2, however, had more days without bleeding (95%) than group 1 (89%).
- Both groups had an improvement in pelvic pain scores with continuous use.
- There was no change in headache or mood changes.
- Of the 65 women who completed the study, 57 decided to keep using the ring continuously.
The majority of women preferred leaving the ring in place, regardless of the breakthrough bleeding or spotting they experienced. Learn more about the contraception ring in our FAQs section.
Sulak PJ, Smith V, Coffee A, Witt I, Kuehl AL, Kuehl TJ. Frequency and management of breakthrough bleeding with continuous use of the transvaginal contraceptive ring – a randomized controlled trial. Obstet Gynecol 2008;112:563-71.
Ask Sexualityandu
I would like to avoid taking hormones and I was wondering what my options are for contraception.
Avoiding sexual intercourse (abstinence) is the only method that is 100% effective. Sterilization is the most effective with rates of pregnancy well below 1%, followed by the copper IUD (around 1%) and then the male condom, for which the failure rates are dependent on the user.
If you and your partner are seeking permanent contraception then sterilization is very effective for either of you. There are several methods of sterilization, all of which involve some form of surgical procedure (tubal ligation for women, and vasectomy for men).
Barrier methods prevent sperm from reaching the egg. These include the male condom, the female condom, the cervical cap, Lea’s shield, and the diaphragm. Spermicide is a requirement for some barrier contraceptives, but does not improve the effectiveness of a condom. Spermicide can also be used on its own.
Intrauterine devices that contain copper, but not hormones, provide long-term pregnancy protection method.
The withdrawal method may be used although this has a high failure rate.
Fertility awareness methods involve monitoring various signs and symptoms to track a woman’s cycle and avoiding intercourse during the times she is more likely to become pregnant.
Talk to your doctor about your options, and visit the contraception section of this website to learn more.
I recently switched from the pill to the Mirena IUS. I’m worried that I will get acne like some of my friends – how often does the Mirena cause acne?
About 5% of women may experience side effects such as weight gain, acne, mood changes or headache. It is more likely that acne occurs because many women change from some form of combined contraception like the pill, patch or ring, which have been shown to improve acne. Whether acne is caused by the Mirena or from discontinuing another form of contraception, it is likely to improve with time as hormone levels stabilize. It is advisable to wait about 6 months to see what happens before discontinuing for this reason. Learn more about the Mirena IUS.
My boyfriend has recently told me that he has a history of genital herpes. We are talking about having sex and I was wondering what we can do to decrease my chances of getting it too?
Genital herpes is caused by herpes simplex virus, either type 1 or 2. Unfortunately it is very common and it cannot be cured completely, but the number of outbreaks usually decreases over time and it does not generally have other long term consequences.
Steps may be taken to decrease the risk of transmission. Although the virus may be transmitted even when a person has no symptoms, it will decrease the risk of transmission to avoid intercourse or intimate activity including intimate touching and oral sex during outbreaks. Otherwise, the use of condoms will decrease the risk, but lesions or viral shedding can occur outside of the area covered by condoms. The person with herpes may also take a daily dose of antiviral medication to decrease the risk of passing the infection to their partner, an option that should be discussed with a doctor. Learn more about sexually transmitted infections.
What is a Lea’s shield and how does it work?
A Lea’s shield is a reusable form of barrier contraception. It is meant to be used with spermicide and should be left in for at least 8 hours after intercourse. Pregnancy rates with proper use are around 9% over 6 months. It does not protect against sexually transmitted infections.
The device fits in the vagina and covers the cervix to prevent sperm from entering. It has a one-way valve to help create a seal between it and the cervix and vagina. It is available in only one size, but should fit anyone with normal anatomy. Most women can correctly fit the device by reading the instructions. To ensure proper placement you can have your doctor examine you after you have inserted it. Learn more about Lea’s shield in our FAQs section.
